Page 1 of 1: medicine: hiv

anavrin_kaerf · Credits: 4038 My Scrapbook

M/C cause of pleural effusion in HIV
-kaposi sarcoma
-p.carinii
-lymphoma
-TB

aceofbase · Credits: 1704 My Scrapbook

LETS ANALYSE THE CAUSES ONE BY ONE

Pneumocystis Carinii Pneumonia
the most common pulmonary opportunistic infection in HIV-infected individuals in the USA and is the first AIDS-defining condition in 65% of HIV-infected persons in the USA

formerly considered to be protozoan, now found to be related to both protozoa and fungi

P. carinii disease is almost exclusively limited to the respiratory system and is acquired thru airborne transmission
90% of individuals have Ab to PCP by age 4 suggesting infection commonly occurs in early childhood
P. carinii pneumonia is an infection of later stages of HIV infection (seldom occurs when CD4 > 200)
Grows within the alveoli in great numbers Þ alveoli become filled with an amorphous foamy eosinophilic exudate containing both cysts and trophozoites of the organism; As illness progresses severe oxygenation failure occurs

PCP symptom presentation:
2-6 wk history of intermittent fever, non-productive cough, and progressive dyspnea on exertion
symptoms are insidious, gradually progressing over wks to months
productive cough, purulent sputum, rigors, and pleuritic chest pain are uncommon and suggest alternative diganosis
most important prognostic factor is the degree of hypoxemia at the time of diagnosis
Physical exam of the thorax is often unremarkable, though a few fine crackles or wheezes may be detectable

Tuberculosis

M. tuberculosis is a highly virulent human pathogen that presents early in the course of HIV infection
Without HIV there is a 5-10% lifetime risk of reactivation of TB
Pts with HIV and TB infection may have as high as an 8% per year risk of developing active tuberculosis
active TB appears to accelerate the course of HIV
Clinical presentation:
Fever, weight loss, night sweats and productive cough
In early HIV, chest x-rays show apical fibrocavitary disease typical of reactivation TB
Presence of cavitation, intrathoracic lymphadenopathy, or pleural effusion is suggestive of pulmonary TB
In later stages of HIV, may present with "atypical" x-ray features – lower lobe infiltrates and hilar lymphadenopatHY

lymphoma
Non-Hodgkin’s lymphomas may present with mediastinal or hilar lymphadenopathy and interstitial or nodular infiltrates
these tumors are high-grade B cell lymphomas
cytology of pleural fluid is diagnostic in 75-100% of effusions due to lymphoma
transbronchial lung biopsies usually do not provide adequate tissue for the diagnosis of pulmonary lymphoma and open lung biopsy is required for definitive diagnosis
EBV infection probably plays an important role in AIDS-associated NHL; almost all patients have (+)EBV serology
the prognosis of AIDS-assoc lymphomas is poor; treatment of AIDS-associated lymphomas is difficult
body cavity lymphoma, which presents primarily with pleural effusions, has been reported in AIDS
it appears to be associated with human herpes virus 8, the same virus that is the causative agent of KS
many reports suggest that lung cancer may occur in AIDS at a younger age

Pulmonary Neoplasms: Kaposi’s Sarcoma
KS pulmonary disease usually occurs in the setting of extensive mucosal and cutaneous disease
KS involves the lungs in 25-75% of patients with AIDS, pulmonary infiltrates and cutaneous KS
Nodular infiltrates with bloody or serosanguinous pleural effusions are the most common radiographic manifestations
Almost all patients with pulmonary KS have extensive KS lesions on the skin or oral mucous membranes
Typical pulmonary KS lesions are peribronchial or perivascular hemorrhagic nodules that may coalesce to form large masses; the nodules contain spindle-shaped cells (with vascular clefts filled with RBCs and hemosiderin) which may infiltrate along the alveolar and intralobular septae, producing a reticulonodular pattern with pleural involvement
On bronchoscopy, typical raised red-purple lesions similar to cutaneous KS plaques are diagnostic for the KS lesions
Up to 50% of patients with pulmonary KS have other potentially treatable opportunistic infections such as PCP or tuberculosis at the time of presentation with pulmonary symptoms
Clinical manifestations of pulmonary KS include fever, cough, and dyspnea
Some patients present with streaky hemoptysis
Definitive diagnosis generally requires open lung biopsy

SINCE TB IS THE MOST COMMON PULMONARY MANIFESTATION OF HIV IN INDIA, I THINK TB SHOULD BE THE ANSWER>

anavrin_kaerf · Credits: 4038 My Scrapbook

hey thanks for the extensive info... but the ANSWER IS KAPOSI1!!Amit ashish medicine..

Akil · Credits: 27618 My Scrapbook

About 70% of pulmonary KS result in Pleural Effusion...

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Akil

Akil · Credits: 27618 My Scrapbook

Parapneumonic effusion, tuberculous effusions and then Malignant effusions due to KS are the most common causes of pleural effusions in HIV

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Akil

Akil · Credits: 27618 My Scrapbook

Infections effusions most common - S. aureus (of course a whole lot of other organisms and even fungi may be causative in HIV at advanced stages!)

Of Malignant effusions - KS

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Akil

anavrin_kaerf · Credits: 4038 My Scrapbook

hey whats ur reference akki?

Akil · Credits: 27618 My Scrapbook

anavrin_kaerf · Credits: 4038 My Scrapbook

yup...

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